Himali Weerahandi MD, MPH, Marisha Burden MD, MBA, Zoë Kopp MD, Catherine Callister MD, Jamie Burke BS, Khooshbu Dayton MD, Angela Keniston PhD, MSPH, Russell Ledford MD, Katie E. Raffel MD, Jeffrey Schnipper MD, MPH, Andrew Auerbach MD, MPH
{"title":"临床医生对电子健康记录行为警报和医院工作场所暴力预防的看法：在 20 家机构开展的混合方法研究。","authors":"Himali Weerahandi MD, MPH, Marisha Burden MD, MBA, Zoë Kopp MD, Catherine Callister MD, Jamie Burke BS, Khooshbu Dayton MD, Angela Keniston PhD, MSPH, Russell Ledford MD, Katie E. Raffel MD, Jeffrey Schnipper MD, MPH, Andrew Auerbach MD, MPH","doi":"10.1002/jhm.70018","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Workplace violence prevention programs are important for safety, but little is known about how they are perceived by clinicians or whether electronic health record (EHR) behavioral alerts are perceived as effective.</p>\n </section>\n \n <section>\n \n <h3> Objective</h3>\n \n <p>To understand perspectives on the use of EHR behavioral alerts as part of workplace violence prevention programs in hospitals.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Mixed methods study utilizing semi-structured focus groups with a structured survey. Focus group participants were members of a national hopsitalist consortium.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Twenty-eight individuals from 20 different organizations participated in focus groups, with 24 (86%) completing the survey. There was broad uncertainty in best practices for inpatient workplace violence prevention. There was also wide variation in EHR behavioral alert use across multiple domains, including how and why the alerts are placed and how they are used by the end user. Finally, focus groups had mixed sentiments on the potential impacts of these alerts; among participants who responded to surveys, half (50%) noted that alerts caused deviations in care and 21% indicated they witnessed instances where behavioral alerts led to adverse patient outcomes. Most (67%) survey respondents did not think EHR behavioral alerts prevented workplace violence. The majority (88%) of respondents also reported that patient demographic factors impacted whether an alert was placed.</p>\n </section>\n \n <section>\n \n <h3> Limitations</h3>\n \n <p>The study focused on clinician experience at academic hospitals.</p>\n </section>\n \n <section>\n \n <h3> Conclusions and Relevance</h3>\n \n <p>Reports of uncertainty in best practices for deploying EHR behavioral alerts, along with perceptions of variability in implementation and potential biases in alert usage, raise concerns about their effectiveness and potential for worsening disparities. Standardized, evidence-based practices that safeguard healthcare workers without compromising patient care and equity are needed.</p>\n </section>\n </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 8","pages":"837-846"},"PeriodicalIF":2.3000,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Clinician perspectives on electronic health record behavioral alerts and hospital workplace violence prevention: A mixed methods study at 20 organizations\",\"authors\":\"Himali Weerahandi MD, MPH, Marisha Burden MD, MBA, Zoë Kopp MD, Catherine Callister MD, Jamie Burke BS, Khooshbu Dayton MD, Angela Keniston PhD, MSPH, Russell Ledford MD, Katie E. Raffel MD, Jeffrey Schnipper MD, MPH, Andrew Auerbach MD, MPH\",\"doi\":\"10.1002/jhm.70018\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Workplace violence prevention programs are important for safety, but little is known about how they are perceived by clinicians or whether electronic health record (EHR) behavioral alerts are perceived as effective.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Objective</h3>\\n \\n <p>To understand perspectives on the use of EHR behavioral alerts as part of workplace violence prevention programs in hospitals.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>Mixed methods study utilizing semi-structured focus groups with a structured survey. Focus group participants were members of a national hopsitalist consortium.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Twenty-eight individuals from 20 different organizations participated in focus groups, with 24 (86%) completing the survey. There was broad uncertainty in best practices for inpatient workplace violence prevention. There was also wide variation in EHR behavioral alert use across multiple domains, including how and why the alerts are placed and how they are used by the end user. Finally, focus groups had mixed sentiments on the potential impacts of these alerts; among participants who responded to surveys, half (50%) noted that alerts caused deviations in care and 21% indicated they witnessed instances where behavioral alerts led to adverse patient outcomes. Most (67%) survey respondents did not think EHR behavioral alerts prevented workplace violence. The majority (88%) of respondents also reported that patient demographic factors impacted whether an alert was placed.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Limitations</h3>\\n \\n <p>The study focused on clinician experience at academic hospitals.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions and Relevance</h3>\\n \\n <p>Reports of uncertainty in best practices for deploying EHR behavioral alerts, along with perceptions of variability in implementation and potential biases in alert usage, raise concerns about their effectiveness and potential for worsening disparities. Standardized, evidence-based practices that safeguard healthcare workers without compromising patient care and equity are needed.</p>\\n </section>\\n </div>\",\"PeriodicalId\":15883,\"journal\":{\"name\":\"Journal of hospital medicine\",\"volume\":\"20 8\",\"pages\":\"837-846\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2025-02-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of hospital medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://shmpublications.onlinelibrary.wiley.com/doi/10.1002/jhm.70018\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of hospital medicine","FirstCategoryId":"3","ListUrlMain":"https://shmpublications.onlinelibrary.wiley.com/doi/10.1002/jhm.70018","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
Clinician perspectives on electronic health record behavioral alerts and hospital workplace violence prevention: A mixed methods study at 20 organizations
Background
Workplace violence prevention programs are important for safety, but little is known about how they are perceived by clinicians or whether electronic health record (EHR) behavioral alerts are perceived as effective.
Objective
To understand perspectives on the use of EHR behavioral alerts as part of workplace violence prevention programs in hospitals.
Methods
Mixed methods study utilizing semi-structured focus groups with a structured survey. Focus group participants were members of a national hopsitalist consortium.
Results
Twenty-eight individuals from 20 different organizations participated in focus groups, with 24 (86%) completing the survey. There was broad uncertainty in best practices for inpatient workplace violence prevention. There was also wide variation in EHR behavioral alert use across multiple domains, including how and why the alerts are placed and how they are used by the end user. Finally, focus groups had mixed sentiments on the potential impacts of these alerts; among participants who responded to surveys, half (50%) noted that alerts caused deviations in care and 21% indicated they witnessed instances where behavioral alerts led to adverse patient outcomes. Most (67%) survey respondents did not think EHR behavioral alerts prevented workplace violence. The majority (88%) of respondents also reported that patient demographic factors impacted whether an alert was placed.
Limitations
The study focused on clinician experience at academic hospitals.
Conclusions and Relevance
Reports of uncertainty in best practices for deploying EHR behavioral alerts, along with perceptions of variability in implementation and potential biases in alert usage, raise concerns about their effectiveness and potential for worsening disparities. Standardized, evidence-based practices that safeguard healthcare workers without compromising patient care and equity are needed.
期刊介绍：
JHM is a peer-reviewed publication of the Society of Hospital Medicine and is published 12 times per year. JHM publishes manuscripts that address the care of hospitalized adults or children.
Broad areas of interest include (1) Treatments for common inpatient conditions; (2) Approaches to improving perioperative care; (3) Improving care for hospitalized patients with geriatric or pediatric vulnerabilities (such as mobility problems, or those with complex longitudinal care); (4) Evaluation of innovative healthcare delivery or educational models; (5) Approaches to improving the quality, safety, and value of healthcare across the acute- and postacute-continuum of care; and (6) Evaluation of policy and payment changes that affect hospital and postacute care.
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